NPIMap

Organization Active NPI

Valley Ambulatory Surgery Center, LP

Doing business as Valley Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • St Charles, IL
National Provider Identifier
1104819424
Registry record updated Sep 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
7001217 Issued in IL
Legal business name
VALLEY AMBULATORY SURGERY CENTER, LP
Doing business as
Valley Ambulatory Surgery Center
Practice address
2475 Dean St
St Charles, IL 60175
Phone
(630) 584-9800
Fax
(630) 584-9805
NPI assigned
Aug 23, 2005
Last updated
Sep 30, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer B. Baldock
Title
Officer and Authorized Official
Phone
(615) 234-5900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 7001217 IL Primary

Addresses

Primary practice location

2475 Dean St
St Charles, IL 60175

Mailing address

2475 Dean St
St Charles, IL 60175-4831
Phone (630) 584-9800

Other practice location 1

2210 Dean St
St Charles, IL 60175-1059
Phone (630) 584-9800

Other identifiers 1

IdentifierTypeStateIssuer
7001217OtherILIL DEPT PUBLIC HEALTH

Other names 1

  • Valley Ambulatory Surgery Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070727000675 IL Part B Supplier - Ambulatory Surgical Center 8921109422 Practice locations: St Charles, IL

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Valley Ambulatory Surgery CenterCCN 14C0001031
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569801600000",
    "number": "1104819424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2475 DEAN ST",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601754831",
            "telephone_number": "630-584-9800",
            "fax_number": "630-584-9805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2475 DEAN ST",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "60175",
            "telephone_number": "630-584-9800",
            "fax_number": "630-584-9805"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2210 Dean St",
            "address_purpose": "LOCATION",
            "city": "St Charles",
            "state": "IL",
            "postal_code": "601751059",
            "country_code": "US",
            "telephone_number": "630-584-9800",
            "fax_number": "630-584-9805",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VALLEY AMBULATORY SURGERY CENTER, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-23",
        "last_updated": "2019-09-30",
        "status": "A",
        "authorized_official_last_name": "BALDOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OFFICER AND AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-234-5900"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IL",
            "license": "7001217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL DEPT PUBLIC HEALTH",
            "identifier": "7001217",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Ambulatory Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Charles, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.